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Without updated laws, doctors face prison for helping patients die on their own terms

Two decades ago, a woman who was deeply involved in the right-to-die movement, died at home in Toronto after a long, gruesome illness. She was surrounded by her family, her doctor and her closest friends.

Some days later, her obituary appeared, noting that cremation had taken place and a memorial service would be announced on a future date.

The next week, my wife, who is a physician, received a knock on her office door.

“Dr. Marmoreo,” her medical secretary said: “There are two Toronto homicide detectives in reception. They want to speak with you.”

They wanted her to confirm that she was the family doctor of the woman from the right-to-die movement.

Yes, she was.

Was she at her bedside when she died?

No, she wasn’t.

Could she prove that?

Yes, she could.

Did she know who the doctor was at her bedside?

No, she didn’t.

The police then took the patient’s medical records and left.

When my wife got home that night and told me the story, she said she thought what got the officers’ suspicions up was not only the woman’s high profile and obvious desire to have her life ended, but the fact the cremation happened so quickly after her death, making an autopsy impossible.

For days I scanned the news waiting to hear some doctor was being charged with murder. But no doctor was.

The news this month that an Ontario judge has ruled patients who want doctor-assisted death have to get permission from the court beforehand is outraging critics.

Having to petition a judge costs money, time and dignity, assets that many dying patients lack.

But doctors aren’t happy either. Who wants to go to prison not just for taking a patient’s life, but for disobeying a court order?

This got me to thinking: “How many doctors have been prosecuted for helping their patients die?” It turns out, hardly any.

In fact, across Canada only seven doctors and one nurse have been charged, even fewer have been prosecuted, and only one has served time behind bars.

• In 1982 in Calgary, Dr. Nachum Gal, a pediatric resident visiting from Israel, ordered extra morphine for a newborn baby with severe brain damage. The baby had been removed from life support at her parent’s request. Dr. Gal returned to Israel and the government of Alberta unsuccessfully fought his extradition. But the nurse who injected the lethal dose of morphine and the supervising nurse were both suspended for one year.

• In 1992 in Toronto, nurse Scott Mataya was charged with first degree murder in the death of a dying patient. He pleaded guilty to a lesser charge, receiving a suspended sentence and lost his nursing license.

• Also in 1992 an unnamed Ontario surgeon administered morphine and potassium chloride to his seriously ill patient who died of cardiac arrest. The surgeon was originally charged with second-degree murder, but a year later the murder charge was withdrawn and he was given a three-year suspended sentence after pleading guilty to the charge of administering a noxious substance.

• In 1993 in Toronto, surgeon Dr. Alberto De La Rocha was charged with second-degree murder after a cancer patient received an injection of potassium-chloride. De La Rocha’s sentence was suspended and his penalty was a license suspension of 90 days. He was permitted to avoid that suspension by writing a guideline about withdrawing life support from terminally ill patients.

• In 1996 in Toronto, Dr. Maurice Genereux prescribed a lethal dose of medication to two HIV-positive men. Mark Jewitt took a lethal dose but managed to survive after a friend called him and then called 911. Aaron McGinn died in 1997 from an overdose of sleeping pills provided by Genereux. The doctor went to prison for two years less a day and lost his medical licence. He is the first doctor in Canadian history to be convicted of assisting suicide.

• In 1997 in Halifax, Dr. Nancy Morrison was charged with first-degree murder in the death of a terminally ill patient, who had been removed from life support. The judge refused to commit her to stand trial.

• In 2006 in Vernon, B.C., Dr. Ramesh Kumar Sharma was charged with helping a 92-year-old woman in a nursing home commit suicide. Her attempt was interrupted by nursing home staff. Sharma was sentenced to house arrest for two years less a day and is currently practicing medicine.

Drs. De La Rocha, Morrison and Sharma all appear to be practicing today.

When I asked my wife, who is now becoming a palliative care doctor, if she feels comfortable practicing in this new — and still murky and topsy-turvy — legal environment around assisted-death, she replied: “It’s about time.”